Significance of Trans Fatty Acids and Omega-3 Fatty Acids in Japanese Men with Coronary Heart Disease

Trans fatty acids (TFA) are found naturally in ruminant foods (R-TFA) by biohydrogenation in ruminant animals or industrially produced oils (IP-TFA) by partial hydrogenation of vegetable or fish oils. The intake of TFA mainly IP-TFA is associated with an elevated risk of coronary heart disease (CHD), while some prospective cohort studies showed that R-TFA were associated with a lower risk for sudden cardiac death (SCD). Our case-control study showed that trans-C18:2 isomers (IP-TFA) were significantly higher, and palmitelaidic acid (R-TFA) levels were lower in patients with acute coronary syndrome (ACS) compared with healthy men. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have different effects on cardiometabolic risk factors. Delta-5 desaturase (D5D) is a key enzyme in the conversion of linoleic acid and alpha-linoleneic acid to arachidonic acid (AA) and EPA, respectively. Previous studies reported that low D5D estimated from the ratio of AA to dihomo-gamma linolenic acid predicts the incident cardiovascular disease. In our cross-sectional study with 436 men with ACS, various atherogenic lipid markers such as small dense LDL cholesterol and malondialdehyde-modified LDL were significantly inversely associated with D5D activity. We found that the EPA/AA may be a superior risk marker than DHA/AA in terms of correlation with atherogenic lipid profiles

Effect of Cardiac Rehabilitation in Preventing Implantable Cardioverter Defibrillator Therapy in Patients with Reduced Left Ventricular Ejection Fraction

In patients with implantable cardioverter defibrillators(ICD)or cardiac resynchronization therapy defibrillators(CRT-D), appropriate and inappropriate shocks lead to a higher risk of mortality. Cardiac rehabilitation(CR)is an established therapy for patients with ischemic heart disease and/or congestive heart failure. However, it is unclear whether CR could reduce the need for device therapies. The purpose of the present study was to investigate whether CR reduces device therapies and mortality in patients with severe cardiac dysfunction and ICD or CRT-D. Of the 390 patients who were implanted with an ICD or CRT-D between 1998 and 2015, 222(178 men, 44 women)with a low ejection fraction(EF; <45%)were investigated in this present study. The study cohort was divided into two groups, the CR group(n=70)and the non-CR group (n=152), and baseline clinical characteristics of the two groups were compared. Furthermore, the number of all device therapies, appropriate therapies, inappropriate therapies, and mortality for 1 year after ICD or CRT-D implantation were compared. There were no significant differences in baseline characteristics between the CR and non-CR groups(e.g. age 68.5 vs 66.2 years[P=0.16]; EF 27.9% vs 29.7%[P=0.14]). Kaplan-Meier analysis revealed that all device therapy events and inappropriate therapy events were lower in the CR than non-CR group(P=0.01 and P=0.03, respectively). Appropriate therapy events and mortality did not differ significantly between the two groups(5.7% vs 13.1%[P=0.09]and 11.4% vs 17.0%[P=0.28], respectively). CR may have beneficial effects in preventing therapy events, especially inappropriate therapy, in patients with an ICD or CRT-D